Cafe-au-lait spots with resistant hypertension are an indicator of pheochromocytoma: a rare case report.

This case report is one of the rare cases of bilateral pheochromocytoma associated with neurofibromatosis type 1. The interest lies in the clinical form in which the diagnosis was revealed. We report the case of a 38-year-old woman admitted for severe hypertension resistant to triple therapy. Clinical examination revealed Cafe-au-lait spots, which are pigmented birthmarks that appear as patches on the skin with a light to dark brown colour. More than six spots are present in an estimated 95% of people diagnosed with neurofibromatosis type 1 (NF1). Abdominal computed tomography (CT) showed bilateral adrenal tumor involvement. The diagnosis of pheochromocytoma was made by measuring urinary Vanillylmandelic acid (VMA). The evolution was favorable after the excision of the tumor, with normalization of blood pressure. In conclusion: resistant hypertension with café au lait spots may indicate pheochromocytoma, especially bilateral, suggesting an underlying genetic condition like NF1, warranting systematic screening.

En este reporte se documenta un caso raro de feocromocitoma bilateral asociado a neurofibromatosis tipo 1. El interés radica en la forma clínica en la que se reveló el diagnóstico. Presentamos el caso de una mujer de 38 años que ingresa por hipertensión arterial severa resistente a triple terapia. El examen clínico reveló manchas café con leche, que son marcas de nacimiento pigmentadas que aparecen como manchas en la piel y que son de un color marrón claro a oscuro. Se estima que el 95% de las personas diagnosticadas con neurofibromatosis tipo 1 (NF1) presentan más de seis manchas. La tomografía computarizada (TC) abdominal mostró afectación tumoral suprarrenal bilateral. El diagnóstico de feocromocitoma se realizó mediante la medición del ácido vanilmandélico (VMA) urinario. La evolución fue favorable tras la extirpación del tumor, con normalización de la presión arterial. En conclusión, la hipertensión resistente con manchas café con leche puede indicar feocromocitoma, especialmente si es bilateral, lo que sugiere una afección genética subyacente como la NF1, que justifica un tamizaje sistemático.

Unusual coexistence of restrictive heart disease and Kallmann syndrome: a case report.

BACKGROUND: Kallmann-Morsier syndrome is a rare disease characterized by the association of congenital gonadotropic deficiency and anosmia or hyposmia. The cardiac manifestations associated with this syndrome are little known. Through this case, we will characterize the cardiac involvement of this disease in the light of what is already described in the literature. CASE PRESENTATION: We report the case of a young patient who presented with a picture of cardiac decompensation revealing restrictive heart disease. In her exploration, she was found to have primary amenorrhea, leading to the diagnosis of Kallmann syndrome. Medical treatment was optimized for the management of her cardiac decompensation as well as hormonal replacement treatment for her delayed puberty and growth. CONCLUSIONS: Cardiac manifestations in Kallmann-Morsier syndrome are few reported in the literature, and restrictive heart disease is uncommon with no cases report till now. This association suggests a possible common genetic origin that should be explored in the future.

A rare clinical case of systemic AA amyloidosis with cardiac involvement complicating ankylosing spondylitis: a case report.

BACKGROUND: Ankylosing spondylitis (AS) is a type of chronic inflammation that is most prevalent in young adults and is characterized by an inflammatory enthesiopathy that gradually develops toward ossification and ankylosis. If inflammation is left unchecked, it can potentially lead to complications such as secondary amyloidosis, also known as AA amyloidosis, involving the deposition of amyloid serum A protein. Our case presents with a thyroid localization of AA amyloidosis which is secondary to this AS. Such a case has been described in only four cases in the literature. Cardiac localization of AA amyloidosis has been exceptionally described in the literature. CASE PRESENTATION: We report the case of a young patient with severe AS complicated by secondary amyloidosis with thyroid, cardiac, and probably renal localization. He was treated with anti-TNF therapy, and his condition improved significantly. CONCLUSIONS: Our case presents several localizations of AA amyloidosis secondary to this AS. Although cardiac involvement is rare in secondary AA amyloidosis, it should always be screened for, even in a cardiacly asymptomatic patient.

Two stents' dislodgement in the left main coronary artery: a case report.

BACKGROUND: Stent dislodgement is a life-threatening complication that can result in coronary artery embolization, stent thrombosis, acute myocardial infarction, and even death. Severely angulated, heavily calcified, and previously stented coronary arteries are associated risk factors. With the development of different lesion preparation techniques and the drug eluting stent era, the reported incidence of stent dislodgement has decreased to < 1% in the last few years. CASE PRESENTATION: We report a case of a 64-year-old Moroccan man complicated during percutaneous intervention in the left main artery by the loss of two stents. This complication was successfully managed by passing the stent's balloon into the stent and then fully expanding it. In our case, the device's characteristics were involved and could play a role in such complications, but it is still not well understood. CONCLUSIONS: The main treatment option is stent retrieval with different available techniques. If retrieval of the stent is impossible, crushing it against the blood vessel wall could be considered.

An infective endocarditis complicated by multiple septic emboli: case report.

BACKGROUND: Owing to challenges associated with heart failure and cardiac embolism, infectious endocarditis emerges as a critical pathology characterized by elevated mortality and morbidity rates. Our case stands out as a rare instance of endocarditis involving multisystem embolization, with a successful outcome. CASE PRESENTATION: We present the case of an 81-year-old man whose admission was further complicated by various septic emboli affecting the brain (manifesting as a brain abscess and ischemic stroke), spleen (resulting in splenic infarction), and spinal cord. The patient received a diagnosis of infective endocarditis affecting the native mitral valve. Following prompt medical and surgical intervention, the overall progression was favorable despite encountering several challenges. CONCLUSIONS: This case is notable for its detailed description and analysis of the multiple embolic events. More importantly, it underscores the significance of timely surgical intervention and the collaborative approach of a heart team in the face of complicated endocarditis marked by numerous septic emboli. Despite the typically grim prognosis associated with such cases, the outcomes emphasize the positive impact of timely surgery on prognosis.

Predictors of mortality in heart failure patients with reduced or mildly reduced Ejection Fraction: The CASABLANCA HF Study.

BACKGROUND: Heart failure (HF) poses a significant public health challenge throughout the world and Morocco. Our objective was to delineate the epidemiological characteristics of Moroccan patients living with chronic heart failure and to identify prognostic factors correlated with CHF mortality. RESULTS: A total of 1344 patients participated in this study, with survival rates at 3, 6, and 10 years recorded at 75.2%, 60%, and 34%, respectively. During the follow-up, 886 patients succumbed, representing a mortality rate of 65.9%. A Cox regression model, utilizing baseline candidate variables, was developed to predict cardiovascular (CV) mortality. Predictors all of which had a P value less than 0.05 included age, left ventricular ejection fraction (EF) at commencement (< 35%), hypertension, male sex, anemia, creatinine levels, and the number of hospitalizations due to HF decompensation. Notably, the frequency of hospitalizations emerged as the most potent predictor of mortality, with an HR of 2.5 (95% CI [2-2.9]). Almost 90% of patients with three or more readmissions for HF decompensation experienced mortality by the follow-up's conclusion. CONCLUSIONS: This study offers valuable insights into risk factors and clinical outcomes in HF patients in Morocco. Factors such as male gender, advanced age, a history of hypertension, lower systolic blood pressure, rehospitalizations for HF decompensation, low left ventricular ejection fraction, anemia, and elevated creatinine levels were associated with increased mortality. Medical and health services managers should be aware of the substantial burden and future challenges posed by HF in Morocco, prompting the adoption of multidisciplinary strategies for its management and care.

Ischemic Stroke Revealing Libman-Sacks Endocarditis: A Case Report.

Libman-Sacks endocarditis (LSE) is a characteristic but rare feature of systemic lupus erythematosus (SLE), which can be found in association with antiphospholipid syndrome (APS), exposing the patient to an increased embolism risk, particularly the occurrence of ischemic stroke. We present a case involving a 64-year-old man who was admitted for ischemic stroke accompanied by a fever. Cardiac investigation revealed mitral vegetations along with severe mitral regurgitation. The diagnosis of Libman-Sacks endocarditis associated with SLE and APS was made after a laboratory work-up showing negative blood cultures and positive antibodies. This case underlines the importance of early diagnosis for better management of this pathology.

Left Ventricular Noncompaction Cardiomyopathy and Myocardial Bridging Association: A Coincidence Or a Usual Association?

Left ventricular non compaction (LVNC) is a rare congenital disease. It occurs due to an arrest of the myocardial fibers compaction during embryogenesis. Myocardial bridge (MB) is a coronary anomaly in which the myocardium. covers segments of the coronary arteries. We report a rare case of 62-year-old women who was diagnosed with the association of LVNC and MB revealed by chest pain and dyspnea. Some similar cases were reported in the last two decades suggesting that we may be in front of a usual yet underdiagnosed association. To our knowledge, this is the first case described in the Arab World.

Rare case series of adult interrupted aortic arch.

Interrupted aortic arch (IAA) is a rare congenital heart condition where there is a complete discontinuation between the ascending and descending aorta. The association with a patent ductus arteriosus or developed arterial collateral allows survival until adulthood in extremely rare cases. We report a case series of adult forms of IAA. Even if the incidence is very rare, IAA should be could excluded in the setting of resistant asymmetrical hypertension. The first case is singular regarding its association with a bicuspid aortic valve and aortic aneurysm, while the second case is characterized by massive left ventricular hypertrophy. The diagnosis was suspected on echocardiographic findings and confirmed by computed tomography angiography. Both patients refused surgical repair given the high operative risk. Learning objectives: -The evaluation of severe resistant high blood pressure should include complementary investigation for adult form interrupted aortic arch.-To understand the major impact of multimodality imaging for the recognition, localization, and stratification of interrupted aortic arch.

The national moroccan registry of ST-elevation myocardial infarction (MR-MI).

BACKGROUND: MR-MI is the first national Moroccan ST-elevation myocardial infarction (STEMI) registry. Its objectives are to assess patient management modalities and highlight the clinical and therapeutic characteristics of this pathology in all cardiology centres on a national scale. METHODS: Adult patients presenting with STEMI within 5 days of symptoms onset were enrolled over a period of 18 weeks from April to August 2018. 57 cardiology centres distributed in 22 cities in Morocco participated in the study, including 5 university hospitals, representing 70% of Moroccan centres managing STEMI patients. A case report form was sent to the investigators in both electronic and paper forms. Sociodemographic, clinical, management, revascularization, and follow-up data were collected. RESULTS: A total of 809 patients were recruited. The population was mostly male (74.8%) with an average age of 62.6 ± 11.6 years. The most common risk factors were smoking (38.3%) arterial hypertension (30.7%), and diabetes (28%). 30% of patients were admitted within the first 6 h of symptoms onset and early revascularization was performed on 49.6%. Mortality rate was 5.2% in-hospital and 3.2% at the one-month follow-up. CONCLUSION: MR-MI is the first Moroccan STEMI registry on a national scale. Relevant management delays are much longer than other countries, and less than 50% of the patients that present on time benefit from early revascularization. Efforts remain to be done on the optimal diagnosis and treatment of STEMI.

ST-elevation myocardial infarction complicated by ventricular tachycardia revealing coronary artery ectasia: a case report.

BACKGROUND: Coronary artery ectasia is a rare angiographic finding and results from a disease process that compromises the integrity of the vessel wall. Its prevalence ranges between 0.3% and 5% of patients undergoing coronary angiography (Swaye et al. in Circulation 67:134-138, 1983). Coronary artery ectasia in patients with ST-elevation myocardial infarction is associated with an increased risk of cardiovascular events and death after percutaneous coronary intervention. CASE PRESENTATION: We report the case of a 50-year-old male Caucasian patient, admitted for ventricular tachycardia at 200 beats per minute hemodynamically not tolerated that was reduced by external electric shock. Electrocardiogram after cardioversion showed a sinus rhythm with anterior ST-elevation myocardial infarction. Thrombolytic therapy was chosen after exposure to dual antiplatelet therapy and heparin since the expected time to percutaneous coronary intervention was greater than 120 minutes from first medical contact and the patient presented within 12 hours of onset of ischemic symptoms. The electrocardiogram after thrombolysis showed the resolution of the ST segment. The echocardiogram showed a dilated left ventricle with severe dysfunction with left ventricle ejection fraction at 30%. Coronary angiography revealed non-obstructive giant ecstatic coronaries without any thrombus. A check-up to look for possible etiologies for coronary artery ectasia was carried out and returned normal. Since no etiology for coronary artery ectasia was found at the limit of available exams in our center, the patient was discharged with antiplatelet therapy (aspirin 100 mg once a day) and heart failure treatment with an indication for an implantable cardiac defibrillator. CONCLUSIONS: Coronary artery ectasia in the context of acute myocardial infarction is a rare condition that may have dangerous complications, especially when an optimal treatment for ecstatic culprit vessels is still controversial.

Isolated pericardial hydatid cyst: a case report.

Hydatid cysts are most commonly found in the liver and lungs but rarely in the heart. Most heart hydatid cysts are located in the left ventricle and the interventricular septum. Few cases of isolated pericardial hydatid cysts have been reported in the literature. Cardiac involvement can have serious consequences and can be fatal if the cyst perforates. Methods for diagnosing cardiac hydatid cysts include serological tests and noninvasive imaging tests such as transthoracic echocardiography, computed tomography, and magnetic resonance imagery. Case presentation: Here we report a rare case of an isolated pericardial hydatid cyst in a young woman who complained of sternal chest pain, palpitations, and shortness of breath. The diagnosis of pericardial hydatic cyst in our case was confirmed by serologic tests for hydatidosis and the results of echocardiography and tomography. No other localizations were found after realizing a body scan. The patient was started on oral albendazole and then was referred to surgery for the resection of the cardiac mass. Conclusion: Cardiac hydatid cyst represents a rare disease, frequently associated with fatal complications, which makes its early diagnosis and treatment an urgent priority.

[Cardiovascular diseases in the young patients : Place of the carotid intima-media thickness at the University Hospital-Ibn Rochd of Casablanca]. / Les maladies cardiovasculaires chez les jeunes patients : place de l'épaisseur intima-média carotidienne au CHU-Ibn Rochd de Casablanca.

BACKGROUND: The measurement of intima-media thickness (IMT), long neglected, is a fundamental element in the prediction of cardiovascular events. Vascular Doppler ultrasonography is one of the tools needed to objectify atherosclerosis. OBJECTIVES: The aim of our study is to establish a correlation between cardiovascular events and intima-media thickness. METHODS: We conducted a prospective, cross-sectional and descriptive study over a period of 6 months in the cardiology department of Chu-Ibn Rochd, based on vascular Doppler ultrasound data, presenting a risk factor and or vascular cardiovascular disease of the supra-aortic trunks using a high frequency linear probe (7.5 MHZ) connected to a GENERAL Electric ultrasound machine. Intima-media thickness was considered normal < 0.8 mm in adult patients aged 40-60 years. RESULTS: IMT ≥ 0.8 mm was found in 89.2% of patients out of a total of 102 patients recruited, predominantly male (54.9%) with a mean age of 56 ± 9 years. Cardiovascular risk factors and cardiovascular diseases were associated with an increase in IMT. Diabetics were the most frequent to have an elevated IMT, found at 50.9%, followed by 43.1% of hypertensives, 27.4% respectively between haemodialysis patients and ischemic strokes and 14% in coronary patients with indication of bypass surgery. CONCLUSIONS: Elevated IMT is associated with cardiovascular events and should be sought as their primary indicator in future large-scale studies so that it can be routinely assessed for a cardiovascular risk factor.

[Bilateral adrenal hemorrhage on apixaban in primary antiphospholipid syndrome]. / Hémorragie bilatérale des surrénales sous apixaban dans le syndrome primaire des antiphospholipides.

Adrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome. We present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in 53-year-old women treated by apixaban for previous venous thromboembolism.

Cardiac involvement in cancer patients under chemotherapy and diagnosed with COVID-19: case report and literature review.

Many cases of severe cardiac complications due to Coronavirus disease 2019 (COVID-19) were reported. Cancer and chemotherapy appear to be risk and prognostic factors for COVID-19. A 49-year-old Female, with a history of breast cancer treated by tumorectomy and anthracycline-based chemotherapy was admitted with acute respiratory distress syndrome (ARDS) confirmed as COVID-19. She also had elevated troponin I level (up to 43 g/L), and diffuse myocardial hypokinesia along with severe left ventricle dysfunction on echocardiography. Initial treatment included hydroxychloroquine, azithromycin, corticosteroids and mechanical ventilation. The evolution was marked by QT interval prolongation (QTc=523 ms) and occurrence of cardiogenic shock. The patient died of hemodynamic instability reluctant to resuscitation measures at the 2ndday of hospitalization. COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. Receiving chemotherapy especially anthracyclines may be a precipitating and prognostic factor of cardiac manifestations in COVID-19 cancer patients.

Infective endocarditis secondary to coagulase-negative staphylococcus revealed by endogenous endophthalmitis: Case report.

INTRODUCTION: Endogenous endophthalmitis is a rare disease which remains a diagnostic and therapeutic emergency. Infective endocarditis is the first etiology, and coagulase-negative staphylococcus is most often incriminated in endocarditis on prosthesis and rarely on native valve. CASE REPORT: We report the case of a 70 year old female patient, who has a chronic renal failure on haemodialysis, admitted to the ophthalmology department in endogenous endophthalmitis. Blood cultures, intravitreal sampling and culture of the haemodialysis catheter were positive for a multi-sensitive coagulase-negative staphylococcus. On transthoracic and transoesophageal ultrasound, vegetation was found in the right atrium along the path of the haemodialysis catheter and in the aortic and mitral valves. The patient received intravenous antibiotic and intravitreal injections of antibiotics. The evolution was marked by a systemic improvement but the ocular prognosis was poor and the evisceration decision was taken. DISCUSSION: Endogenous endophthalmitis is related to a metastatic infectious process secondary to haematogenous microbial dissemination. The germs involved are Gram-positive bacteria and occurs very frequently in predisposed conditions. A primary infectious site is found in 90% of cases and this is most frequently endocarditis. Coagulase-negative staphylococci are responsible for 20-45% of endocarditis in prosthetic valves and the prevalence in native valve endocarditis is considered low. CONCLUSION: Endogenous endophthalmitis remains an emergency. The search for a source of infection, primarily endocarditis, is systematic. The improvement of the prognosis depends essentially on the eviction and early treatment of infectious foci in people at risk.

Fortuitous discovery of an anomalous connection of the coronary arteries during an urgent coronary angiography: a case report.

Anomalous connection of the coronary arteries (ANOCOR) is a rare angiographic finding; although most ANOCORs are benign some are a risky condition that can lead to sudden death. Knowing their particularities is important to know how to manage them. With an angiographic prevalence averaging 1%, proximal anomalous connection of the Coronary arteries (ANOCOR) represents a diverse entity. The challenge is to distinguish the benign ANOCOR to reassure the patient from the high risk ANOCOR that may need surgical repair. We present a case of a 52-years-old man admitted to our cath lab for urgent coronary angiography after a non ST segment elevation myocardial infarction. At coronary angiography we found ectopic left anterior descending and circumflex arteries with a culprit lesion on the right non ectopic coronary artery. A computed tomography (CT) scan showed benign ectopic courses of the left anterior descending and circumflex arteries. No surgical repair was indicated.

Aortic infective endocarditis decompensated by alithiasic cholecystitis in a patient on hemodialysis: Case report.

Infective endocarditis is an uncommon disease, which most often affects elderly subjects at risk or with favorable factors. Its prognosis is guarded with complications or decompensating factors that are often formidable. We report the case of an acute endocarditis decompensated by acute alithiasic cholecystitis in a 52-year-old patient, with a history of diagnosed end-stage renal failure (GFR 7 ml/min according to the MDRD) for 4 weeks, of undetermined etiology, undergoing hemodialysis, followed for aortic disease for 6 years (IAO grade II, RAO loose). After 6 weeks, the evolution was favorable under adapted and early antibiotic treatment and associated hygiene measures including gastric rest. Infective endocarditis remains a serious pathology, due to its high morbi-mortality. The association of acute infective endocarditis and acute alithiasic cholecystitis is of reserved prognosis especially on a ground of immunodepression like the end-stage chronic renal failure. This association requires a rapid and efficient management.

Cardiac hydatid cyst in the right ventricle - A rare case report of echinococcosis presentation.

INTRODUCTION: The hydatid cyst (HC) of the right ventricle (RV) is an extremely uncommon and a serious location that can cause sudden death following pulmonary embolism, obstruction of the valvular orifice or anaphylactic shock. CASE PRESENTATION: We report a case of a 14 years-old girl with a HC of the RV. Surgical excision of the HC under Cardiopulmonary bypass (CPB) was successful in managing this rare case. CLINICAL DISCUSSION: Cardiac HC is extremely rare. It represents only 0.5-2% of all hydatid cases. However, RV location is very severe. It has a tendency to rupture intracavitarily and causes sudden death in 30% of cases. Its diagnosis is based on echocardiography, computed tomography scan and magnetic resonance imaging. The surgical treatment under CPB with anthelmintic therapy seems to improve the prognostic outcomes. CONCLUSION: Cardiac HC must be always suspected in endemic countries, especially in patients with a family history of HC.

Diagnostic approach to a cardiac mass: a case report of misdiagnosed cardiac synovial sarcoma.

BACKGROUND: Cardiac synovial sarcoma (CSS) is an extremely rare malignant tumour with a poor prognosis. We report the case of a 31-year-old woman who presented with a CSS in the right atrium and was initially misdiagnosed with a tuberculoma. The aim of this article is to focus on the importance of having broad differential diagnoses including rare entities. CASE SUMMARY: A 31-year-old White woman, with a close contact with a relative having pulmonary tuberculosis, presented to the emergency unit with severe dyspnoea. Chest radiography and echocardiography showed a large pericardial effusion with a mass in the right atrium. Pericardiocentesis removed bloody exudative fluid with adenosine desaminase at 17 UI/L and no malignant cells in the cytological study. Cardiac magnetic resonance revealed a tuberculoma of the right atrium. Intraoperatively, the mass was only biopsied because of the local invasion. Histological study concluded to a CSS. The patient died 3 days later. DISCUSSION: This case highlights the importance of having broad differential diagnoses including rare entities. Histology was the key investigation for the diagnosis of CSS which has no clinical nor laboratory or imaging pathognomonic signs.